Chapter 21- Perioperative Nursing Nursing School Test Banks

 

1.

The recovery nurse is caring for a surgical patient in the PACU. The patients blood pressure is dropping and their heart rate is increasing. The nurse suspects the patient is:

A)

overmedicated.

B)

experiencing normal adaptation to the postoperative period.

C)

allergic to the anesthesia.

D)

developing shock.

Ans:

D

Feedback:

Decreasing blood pressure and an increased pulse rate in the postoperative patient are significant because they may signify hemorrhage or shock.

2.

Following a surgical procedure, which of the following are generally responsible for moving the patient to the recovery area?

A)

The surgeon

B)

The orderly

C)

The recovery nurses

D)

The anesthesiologist, circulating nurse, and surgeon

Ans:

D

Feedback:

After the intraoperative phase of the surgical procedure has been completed, the circulating nurse, the anesthesia provider, and the surgeon safely transport the patient to the PACU, taking care to maintain the patients airway during this critical time.

3.

The nurse is caring for the postoperative patient in the PACU. The patient is concerned about the abdominal staples closing her wound for fear they will open and her insides will fall out. Which of the following is the best response by the nurse?

A)

Dont worry, the staples are properly placed and will not come out until they are removed by the physician.

B)

If you are very careful and follow your postoperative instructions, there is no need to worry.

C)

There are sutures in various levels below the staples that assist in keeping your wound intact.

D)

Would you tell me why you are worried about that?

E)

That is possible, but we will keep a close eye on the staples.

Ans:

C

Feedback:

A patient may have absorbable sutures closing the viscera and staples approximating the wound edges.

4.

The nursing instructor is discussing the role of the circulating nurse in the operative suite with the student nurses. Which of the following would the nursing instructor include as duties of the circulating nurse? Select all that apply.

A)

The circulating nurse is included in the responsibility of accounting for all sponges and instruments following the surgical procedure.

B)

The circulating nurse is responsible for preparing the surgical table for the procedure.

C)

The circulating nurse is responsible for assisting the surgeon with instruments during the procedure.

D)

The surgical nurse is responsible for maintaining the patients rights during the surgical procedure.

Ans:

A, D

Feedback:

The circulating nurse ensures that the patients rights are protected and coordinates patient care in the operating room. The circulating nurse and the scrub person are responsible for accounting for all sponges and instruments at the close of surgery.

5.

The adult male patient with significant body hair is being prepared for abdominal surgery. The patient states his dad had the same surgery many years ago and was shaved prior to the procedure. The nurse would explain to the patient:

A)

That practice is no longer standard as shaving may cause breaks in the skin.

B)

We no longer shave skin before procedures but we will apply a lotion that will remove the hair.

C)

Your abdomen will be shaved in the operating room.

D)

You will be shaved as well.

Ans:

A

Feedback:

A surgical prep, or shaving of the hair in the affected area, was a common preoperative procedure a decade ago. Current research indicates that preoperative shaving increases the risk for surgical site infection by causing tiny breaks in skin integrity.

6.

The nurse is preparing to start an IV in the preoperative adult patient. The nurse would likely choose which gauge of IV catheter?

A)

22 gauge

B)

25 gauge

C)

18 gauge

D)

14 gauge

Ans:

C

Feedback:

For any surgical patient, a large-gauge (e.g., 18-gauge) IV device should be used in case a blood transfusion is necessary during the surgical or postoperative period.

7.

The healthy adult patient is given a narcotic prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the patient. Which of the following should the nurse do first?

A)

Immediately have the patient sign the consent form.

B)

Have the patients family member sign the consent form.

C)

Ask the patient if he still wants to proceed with the procedure.

D)

Notify the physician of the oversight.

Ans:

D

Feedback:

Do not administer any medications that might alter judgment or perception before the patient signs the consent form because many drugs commonly administered as preoperative medications, such as narcotics or barbiturates, can alter cognitive abilities and invalidate informed consent.

8.

The patient has been transported to the operating suite and positioned on the operating table. Suddenly, the patient states, I dont want to do this. Get me out of here now! Which of the following actions should occur?

A)

The patient should be given the anesthesia.

B)

The surgeon should tell the patient to remain calm and the procedure will be over soon.

C)

The patient should be told it is too late to change his mind.

D)

The procedure should be stopped.

Ans:

D

Feedback:

The patient has the right to ask any questions and to withdraw consent at any point before the surgery begins.

9.

Which of the following personnel are legally responsible for obtaining the patients informed consent for a surgical procedure?

A)

The surgeon

B)

The registered nurse

C)

The admissions clerk

D)

The licensed practical nurse

E)

Any licensed person

Ans:

A

Feedback:

The surgeon is legally responsible for obtaining the patients informed consent.

10.

The preoperative patient has called the nurse about his upcoming surgical procedure, which will be six weeks from now. He is concerned about receiving blood after surgery for fear of acquiring a bloodborne disease. Which of the following might the nurse do?

A)

Instruct the patient to notify the physician.

B)

Remind the patient that blood is tested prior to administration, making it safe and free of disease.

C)

Ask the patient if he has ever had any blood products.

D)

Explain to the patient the use of autologous blood donation.

E)

Instruct patient to refuse transfusion.

Ans:

D

Feedback:

Because of the fears of hepatitis B and human immunodeficiency virus infection associated with blood transfusion, donation of autologous blood (ones own blood) for surgery is becoming a common practice. If the patient wishes, provide the necessary information about blood donation if the patient is seen a number of weeks before surgery.

11.

The nurse is caring for a patient admitted for an outpatient surgical procedure. Which of the following will the nurse include in the care?

A)

Begin discharge teaching as soon as the procedure is completed.

B)

Allow family members to be present during discharge teaching.

C)

Begin discharge teaching in the preoperative period.

D)

Investigate the patients home care and discharge transportation following the procedure.

E)

Discuss discharge transportation during the preoperative period.

Ans:

B, C, E

Feedback:

Patient teaching begins during the preoperative period and continues throughout all perioperative phases of care. In the preoperative phase, assess the patients and familys readiness to learn and their knowledge base so that teaching can be individualized. If the patient will be discharged on the day of surgery, be sure to identify someone who can take the patient home and assist during the postoperative recovery period.

12.

When an elderly client is brought to the recovery room and presents with irregular, loud respirations, the nurse determines that this most likely a result of

A)

Effects of anesthesia

B)

Normal return of reflexes

C)

Partial airway obstruction

D)

Type of surgery

Ans:

C

Feedback:

Loud, irregular respirations may indicate obstruction of the airway, possibly from emesis, accumulated secretions, or client positioning that allows the tongue to fall to the back of the throat.

13.

A client states he has a latex allergy. What action should the nurse take?

A)

Inform the client to tell the anesthesiologist

B)

Have the client take a Benadryl before surgery

C)

Send the client to the OR with epinephrine

D)

Place an allergy identification band

Ans:

D

Feedback:

Assist client with allergies to medications, food, and latex before the surgical procedure, and clearly mark them on the client record and on the client identification band.

14.

A client has been taking aspirin since his heart attack in 1997. The client is at risk for

A)

Infection

B)

Thrombophlebitis

C)

Hemorrhage

D)

Blood clots

Ans:

C

Feedback:

Current medication use, especially use of medications that can affect coagulation status (warfarin, nonsteroidal anti-inflammatory drugs, aspirin) is important and should be reported to the surgeon.

15.

The removal of a toddlers clothing and application of monitoring equipment after anesthesia is administered will

A)

Minimize blood loss

B)

Ensure temperature control

C)

Provide baseline vital signs

D)

Allow sufficient relaxation

Ans:

D

Feedback:

Relaxation can be enhanced by removing the childs clothing, applying the grounding pad, and applying monitoring devices after the child is anesthetized.

16.

A client is being discharged following surgery for cancer care. The client will require extensive dressing changes two times per day. The client is on a fixed income and cannot afford to purchase dressing supplies. The nurse contacts the local Peregrine Society to assist in the provision of dressings. This contribution in care will assist in improving the clients

A)

Family relationships

B)

Return to daily activities

C)

Decision making

D)

Self-concept

Ans:

D

Feedback:

In addition to providing the client with the necessary technical care, teaching, extensive rehabilitation, and emotional support, nursing interventions may also include referral to agencies and support groups that can benefit the client after surgery and discharge from the acute care facility.

17.

What nursing action will assist in pain management for a client in the postoperative phase?

A)

Client teaching

B)

Relaxation techniques

C)

Dim lighting

D)

Provide food and medication

Ans:

B

Feedback:

Nursing interventions vital in helping clients cope with pain include administering medications, positioning, relaxation techniques, psychological support, distraction techniques, and appropriate referrals to other health professionals.

18.

Which of the following nursing actions provides the greatest assistance in healing?

A)

Maintaining a restful environment

B)

Providing solid food in the first day

C)

Allowing family members to visit often

D)

Keeping the client recumbent

Ans:

A

Feedback:

The nurse should plan for adequate periods of rest and sleep, maintaining a quiet, restful environment.

19.

In the postoperative phase of abdominal surgery, the client complains of severe abdominal pain, and in the second postoperative day, the clients bowel sounds are absent. What does the nurse suspect?

A)

Normal response

B)

Abdominal infection

C)

Hernia development

D)

Paralytic ileus

Ans:

D

Feedback:

A potential complication after surgery is paralytic ileus, a condition in which there is decreased bowel functioning.

20.

What is the rationale for having the client void before surgery?

A)

To assess for pregnancy in women

B)

To assess for urinary tract infection

C)

To prevent bladder distention

D)

To prevent electrolyte imbalance

Ans:

C

Feedback:

Having the client void before surgery will assist in the prevention of bladder distention during or after the procedure.

21.

The nurse-anesthetist is monitoring his client during surgery. He notices a ventricular dysrhythmia and unstable blood pressure. He notifies the surgeon. The operative team suspects

A)

Myocardial infarction

B)

Malignant hyperthermia

C)

Mitral valve prolapse

D)

Major blood loss

Ans:

B

Feedback:

The symptoms of malignant hyperthermia are masseter muscle rigidity, ventricular dysrhythmia, tachypnea, cyanosis, skin mottling, and unstable blood pressure.

22.

Surgery can lead to hypothermia. Of the following clients, who is at greatest risk for hypothermia?

A)

A woman delivering by C-section

B)

An adolescent for arthroscopic surgery

C)

A young adult with a fractured leg

D)

An elderly man with a fractured hip

Ans:

D

Feedback:

The risk of hypothermia increases in the very young and the very old.

23.

Which of the following statements, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?

A)

I can have a hamburger and French fries as soon as I wake up.

B)

The better I eat before surgery, the more likely I will heal.

C)

I might be sick to my stomach and throw up after surgery.

D)

When I can eat again, the best meal would be steak and orange juice.

Ans:

A

Feedback:

Oral fluid and food may be withheld until intestinal motility resumes.

24.

What is the rationale for the administration of IV cephalosporin antibiotic before surgery?

A)

To prevent the development of strep

B)

To prevent the development of pneumonia

C)

To allow for decreased level of white blood cells

D)

To allow the client high levels of medication

Ans:

D

Feedback:

A cephalosporin antibiotic is administered just before the surgical procedure so that the level of medication circulating in the clients blood will be high during surgery.

25.

A client in the immediate postoperative period begins to complain of nausea and ultimately begins vomiting. The nausea and vomiting is most likely related to

A)

Movement of bowels during surgery

B)

Inactivity and emotional upset

C)

The effects of anesthetic agents

D)

Severe pain at the operative site

Ans:

C

Feedback:

Nausea and vomiting can occur postoperatively from the effects of anesthetic agents.

26.

When educating a client in the postoperative period, it is important to educate the client to consume a diet high in

A)

Protein

B)

Calcium

C)

Bicarbonate

D)

Potassium

Ans:

A

Feedback:

After surgery, a diet with sufficient amounts of protein and vitamins A and C helps rebuild tissues and promotes wound healing.

27.

Which of the following clients will see the greatest permanent changes in lifestyle following surgery?

A)

Right total knee replacement

B)

Left mastectomy

C)

Ileostomy

D)

Appendectomy

Ans:

C

Feedback:

Permanent changes in the clients activity level may occur as a result of surgery. The client with an ileostomy will encounter the greatest changes in lifestyle.

28.

A client has arrived in the same-day surgery suite. He states to the nurse, I am so worried about being put to sleep and having the surgery. What would be the nurses best response?

A)

You dont have to worry. It will be fine.

B)

Tell me what you are most worried about.

C)

I will have the anesthesiologist talk to you.

D)

Have you ever had surgery before?

Ans:

B

Feedback:

The nurse should first assess what the client is most worried about or fearful of and then provide emotional support.

29.

Which of the following surgical clients will return to activities in their everyday lives more quickly?

A)

Vaginal hysterectomy

B)

Laparoscopic cholecystectomy

C)

Right nephrectomy

D)

Open-heart surgery

Ans:

B

Feedback:

Clients who have surgery using a laparoscope are able to return to previous activity levels much sooner.

30.

The nurse knows the term perioperative phase refers to care given to the client

A)

Before, during, and after the operative phase

B)

From the start of surgery until its conclusion

C)

Immediately before an operative procedure

D)

Immediately after the operative phase

Ans:

A

Feedback:

Perioperative nursing includes three distinct phases: preoperative, intraoperative, and postoperative.

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